News, Skilled Nursing Facility

CMS offers new settlement option for appeals pending at OMHA and DAB

On November 3, 2017, CMS announced that they will offer an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.

The low volume appeals settlement option (LVA) will be limited to appellants with a low volume of appeals pending at OMHA and the Council. Specifically, appellants with fewer than 500 Medicare Part A or Part B claim appeals pending at OMHA and the Council, combined, as of November 3, 2017, with a total billed amount of $9,000 or less per appeal could potentially be eligible, if certain other conditions are met. CMS will settle eligible appeals at 62% of the net allowed amount.

Separately, OMHA will be expanding the Settlement Conference Facilitation Process for certain appellants that are not eligible for the LVA option. More information will be available on the OMHA website.

Featured Free Resource

Are you prepared to prevent financial burden under PDGM? To ensure success, agencies must take actionable steps now to fully understand exactly how the new Patient-Driven Groupings Model will impact coding scenarios and how these updates will affect revenue cycle.

Free Resources

What will your revenue and expenses look like for a Medicare Part A resident admitted under PDPM? Find out with this free questionnaire from The Association for Medicare Billing and Reimbursement (AMBR) for Long-Term Care.

The way agencies get paid and aspects of almost all areas of business will completely shift under the new Patient-Driven Groupings Model (PDGM). We’ve partnered with industry experts and rounded up crucial action-items you won’t want to overlook as you prepare for this massive change.

Are you prepared to prevent financial burden under PDGM? To ensure success, agencies must take actionable steps now to fully understand exactly how the new Patient-Driven Groupings Model will impact coding scenarios and how these updates will affect revenue cycle.

Complimentary Networking Event for Post-Acute Leaders

Our upcoming Post-Acute Forum takes place November 18 & 19, 2019 in Phoenix, AZ. This complimentary event is specifically designed for decision-makers at skilled nursing facilities and home health agencies.